The overarching goal of the T2DM and Obesity Prevention Core is to support translational research on T2DM and obesity prevention that is practical, adoptable, transportable and sustainable in different health settings. The Core focuses on translational prevention among two vulnerable populations, pregnant and postpartum women, especially those with gestational diabetes, and children. The Core also addresses health disparities among these populations and supports the use of heath information technology.

Specific aims of this HDS-CDTR Diabetes and Obesity Prevention Core include the following:

1: Bring together in one Core leading national experts in translational T2DM and obesity prevention to support research aimed at preventing excessive gestational weight gain, GDM, progression to T2DM in postpartum women and development of obesity in children.

2: Foster and support research to advance the development and implementation of novel methods to deliver and evaluate health system level T2DM and obesity prevention programs, with an emphasis in women of reproductive age and children.

3: Provide consultation to health systems to evaluate their programs related to T2DM and obesity prevention and encourage use of patient outreach modalities that have the potential to increase patient uptake and engagement in those programs.

4: Continue the following Core activities:

a. Provide intellectual and financial support to junior investigators within our HDS-CDTR research centers to propose, develop and conduct translational research projects focused on T2DM and obesity prevention.

The over-arching goal of the Health Disparities Core is to create capacity and collaborations that evaluate existing models of care and the effects of translational interventions across social groups. We will continue to support junior investigators in the study of diabetes translational research projects with an emphasis on monitoring of ethnic group-specific effects after implementation of new translational intervention and quality improvement efforts. The Health Disparities Core will continue to disseminate knowledge of methods and findings of diabetes translational disparities research through collaborations, meetings, and publications, and share expertise with health systems on models of care. The specific aims of the Health Disparities Core are to:

1: Provide intellectual and financial support to junior investigators within our HDC-CDTR research centers to propose, develop and conduct diabetes translational research projects focused on health disparities, including providing support to health disparities-related projects funded through the Pilot and Feasibility Core.

2: Disseminate knowledge of the methods and findings of diabetes translational research on health disparities through seminars, conference presentations and publications.

3: Create a collaborative environment of intellectual sharing and dissemination of findings between research sites within our CDTR and among all NIDDK-funded CDTRs, and communicate research activities and findings relevant to health disparities.

The importance of health information technology (HIT) and the potential for more effective use of increasingly sophisticated HIT technology to achieve improvements in diabetes prevention and care in the U.S. is widely recognized. The Health Delivery Systems Center for Diabetes Translational Research (HDS-CDTR) HIT Core provides access to key HIT tools, methods, and expertise with demonstrated potential to improve diabetes care and primary prevention of diabetes. Our Health IT Core has been very productive during the past funding period.

HIT research done in the past decade, including many projects conducted by CDTR faculty within and among the multiple care delivery systems at which we work, has demonstrated clinically and statistically significant improvement in multiple clinical domains related to diabetes care and prevention, and been a critical part of multiple component interventions that have led to dramatic improvement in diabetes care quality in recent years, in both observational and interventional research studies. However, translation of these “big data” approaches, and of and efficacious HIT single component and multiple component intervention strategies into broad use within the larger U.S. healthcare system is constrained by a number of factors. Constraints include interoperability issues, intellectual property issues, resource availability, and technological challenges. The overall objective of the HIT Core is to support and accelerate the translation of effective HIT systems and practices that are now used in limited settings to broader use in more healthcare delivery systems and medical groups.

To accomplish this overall objective, the CDTR HIT Core focuses on the five types of HIT applications that we believe have the greatest potential for translation into clinical and public health practice. For each of these 5 types of HIT applications, our dual purpose is (i) to translate what works into brooder practice, and (ii) to carefully observe variation in impact across various practice settings to better understand and further accelerate implementation of effective HIT applications. The five HIT applications we identify for special focus include: (a) Web-based EHR-linked Clinical Decision Support (CDS) at various types of clinical encounters; (b) EHR-derived “smart” registries and population management tools that direct attention to specific patient subgroups based on clinical needs and potential benefits; (c) development of informatics infrastructure to support conduct of low-cost pragmatic clinical trials; (d) comparative effectiveness research (CER) that uses large databases and sophisticated statistical approaches such as marginal structural modeling to compare the effectiveness of both established and new approaches to diabetes care and prevention; and (e) HIT-enabled large distributed data networks that can accelerate research related to diabetes care, diabetes prevention and the success of translational efforts.

Safety Net National ResourceThere is now broad agreement that the Type 2 diabetes epidemic is arising from a constellation of socioecologic forces. These socio-environmental exposures accompany social disadvantage and poverty, with the result that vulnerable populations bear the brunt of the epidemic. Our CDTR Safety Net National Resource Core openly acknowledges and addresses this public health reality by partnering with social safety net systems across the US that serve individuals, families and communities at greatest risk of diabetes and its complications across a wide range of social needs. Our overarching goal is to provide translational investigators from our CDTR and our affiliates a critical set of services and resources, as well as access to our expertise and to new networks, enabling them to conduct their funded research more efficiently and effectively. We focus on the social safety net for this Core in accordance with “Sutton’s Law.” When the infamous bank robber, Willie Sutton, was queried by a reporter as to why he robbed banks, he replied simply, "Because that's where the money is." Similarly, although more benevolently, we aim to make available new collaborations that can create openings for diabetes translational researchers to develop innovative social and medical interventions for at-risk populations in the places they receive services, and on their terms. In other words, we propose building research bridges with social service agencies, including safety net healthcare systems, because that’s where the at-risk people are.

A key component of the Health Delivery Systems Center for Diabetes Translational Research (HDS-CDTR) is its Pilot and Feasibility Program. This program fosters and supports pilot projects in diabetes translational research led by promising early stage investigators at the Center’s sites. The specific aims of this Program are: 1. To support two Pilot and Feasibility studies in each year of the HDS-CDTR renewal; 2. To conduct peer review of Pilot and Feasibility award applications on an annual basis, using the following criteria: overall impact; relevance to diabetes translational research; the promise for leading to an R-level grant submission; relevance to the Center’s Translational Research Cores; and support of the health care delivery system in which they are initiated; 3. To leverage the Pilot and Feasibility awards as a mechanism to support junior investigators in developing robust careers in translational research in diabetes and diabetes prevention.